The West Allis-West Milwaukee School District administration recommended the district renew its fully insured UnitedHealthcare plan for 2026 with several plan design changes intended to reduce the proposed rate increase.

The recommendation would raise overall premiums about 11% compared with a negotiation without plan changes that had pegged an earlier renewal higher; administration said that reversing all changes would have produced a larger increase that would have a substantially greater budget impact. The board heard a staff presentation on plan experience, market options and the trade-offs of higher prescription drug cost-sharing and reduced wellness funding.

Why it matters: Health insurance is the district’s largest employee benefit expense and affects both the district budget and employee paychecks. Board members pressed staff on how changes would affect access to care and the district’s budget position.

District staff and outside brokers briefed the board on the district’s 2025 claims experience and on market proposals for 2026. Staff said the district’s loss ratio through April 2025 was about 105.1 — roughly $5.8 million in paid claims against about $5.5 million in premium — and that prescription drug costs were a primary driver of recent increases. Presenters said 14 members had more than $50,000 in paid claims through April; five members had paid claims above $100,000.

The administration summarized the market search: brokers solicited fully insured proposals from Anthem, Network Health Plan, WPS and UnitedHealthcare. Presenters said WPS either declined to quote or returned a very high estimate, Network Health Plan and Anthem’s proposals would have produced materially larger increases and would have disrupted the district’s provider network. Staff said UnitedHealthcare’s negotiated renewal without plan changes had been reduced from an initially underwritten higher number down to an 18% increase, and that, with the recommended design changes (raise prescription copays, reduce wellness funding, remove the UnitedHealthcare nurse liaison), the net proposed increase would be roughly 11%.

Board members asked specific questions. Board member Becker asked about the nurse liaison’s role: “I’m curious about our utilization of the nurse liaison,” and staff replied that the liaison had helped employees navigate coverage changes, appeals and provider access and that the liaison also made monthly visits to schools. Board member Lee asked about budget impacts: “So moving from, the original 18%, 11%, how much is that in total gonna save the district?” Staff said the difference helped the district’s health-insurance budget by roughly $180,000 relative to a 15% budget assumption and that the larger, 18% renewal would have produced a larger budget shortfall.

Staff described the three elements used to reduce the renewal number: (1) modest increases in prescription copays (for example, a $10 increase at each tier as proposed in the briefing), (2) a reduction of the district wellness funding from about $750,000 to $550,000 while preserving funding for the on-site clinic and some physical-therapy and gym-reimbursement programs, and (3) elimination of the UnitedHealthcare nurse liaison role, valued in staff comments at about $164,000. Staff said those changes combined would lower the negotiated increase to about 11% overall.

Discussion, not a vote: This item was presented as a financial-stability workshop and no final board action was recorded. Administration said it would proceed with the recommended renewal approach and continue to evaluate both self-funding and market options for future years. Staff also said they will continue planning employee education about plan design, coinsurance and options to reduce out-of-pocket cost.

What’s next: Administration recommended the board approve the renewal approach but did not record a formal vote during the workshop portion of the meeting. Staff said they will return with any formal contract documents and further analyses if board direction changes.